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Int. J. Pharm. Sci. Rev. Res., 40(1), September – October 2016; Article No.

45, Pages: 251-253 ISSN 0976 – 044X

Research Article

Evaluation of Serum Electrolytes in Type II Diabetes Mellitus

Sarguru Datchinamoorthi*, Vanaja R, Balaji Rajagopalan


Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India.
*Corresponding author’s E-mail: sarguru2@gmail.com

Accepted on: 08-07-2016; Finalized on: 31-08-2016.


ABSTRACT
Diabetes Mellitus (DM) is a metabolic disease which is of great concern worldwide. Apart from other factors, the underlying
mechanism pertaining to the electrolyte imbalance has to be explored. Hence it was proposed to study the levels of serum sodium,
potassium and chloride in type II DM patients. 50 confirmed type II DM patients and 50 age and sex matched controls were chosen
for the study. Serum levels of sodium, potassium and chloride were measured. Statistical analysis was performed using Students ‘t’
test. Results showed significantly elevated sodium (hypernatremia), mild elevation of potassium (hyperkalemia) and chloride
(hyperchloridemia). These aberrations could be due to the hypertonicity of blood and redistribution of water and electrolytes
noticed in DM. It may be concluded from this study that dysregulation of glucose homeostasis may lead to electrolyte imbalance
due to increase in sodium & potassium chloride levels.
Keywords: Fasting Blood Sugar( FBS), Diabetes Mellitus (DM), Sodium, Potassium, Chloride.

INTRODUCTION MATERIALS AND METHODS

T he prevalence of DM is of great concern world wide


and 20% to 50% of new-onset type II DM is
observed in young generation1.
Electrolyte imbalance is common in patients with
The study comprised of 50 confirmed type II DM patients
from Shri Sathya Sai Medical College and Hospital.
50 age and sex matched healthy individuals were treated
as controls.
diabetes, which could be the result of an altered
Inclusion Criteria
distribution of electrolytes.
 Patients with type II DM were included
And it is related to hyperglycemia induced osmotic fluid
shifts or of total-body deficits brought about by osmotic Exclusion Criteria
diuresis2.
 The subjects with metabolic syndrome
The insulin mediated glucose intake is impaired, but the
potassium intake of cells remains normal.  Patients with thyroid dysfunction

Hyperkalemia occurs due to increase in plasma tonicity  Blood samples were collected from the controls and
that results from the redistribution of potassium from the patients. Serum Sodium, Potassium and chloride
intercellular space to extracellular space in patients with levels were analyzed using electrolyte analyzer.
type II DM. Biochemical Measurements
Diabetes mellitus produces dysnatremias via several
3-4
 Estimation of Blood glucose was done by GOD-POD
underlying mechanisms. method10 using semi-auto analyzer
Glucose is one of the osmotically active substance. In  Serum electrolytes were measured by using FLEA
hyperglycemia this will increase osmolality of the serum, method using electrolyte analyser
which results in movement of water out of the cells.
Statistical analysis were performed by using Student’s’t’
Uncontrolled DM also induce hypovolumic hyponatremia test,and Pearson’s correlation was used to compare FBS
due to osmotic diuresis. Moreover in diabetes and electrolytes.
ketoacidosis, the urinary electrolyte loss aggravates the
renal sodium wasting5-6. RESULTS

There are contradictory reports regarding the prevalence In this study, 100 subjects were included in which 50
of electrolyte disturbances among patients with type II were diabetic and 50 were age matched healthy controls.
DM7-9. Hence the study was designed to assess the serum Table 1 shows the biochemical measurements which
electrolytes in type II DM. includes HbA1c, FBS, Sodium, potassium and chloride
The aim of this study is to measure the serum Sodium, levels in both diabetic and control groups in which HbA1c
Potassium and chloride levels in type II DM patients. was significantly (P <0.05) elevated in the diabetic

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Int. J. Pharm. Sci. Rev. Res., 40(1), September – October 2016; Article No. 45, Pages: 251-253 ISSN 0976 – 044X

patients when compared with the non diabetic healthy values were found to be (P* 0.017 and r * -0.233) which is
controls. In diabetic patients sodium levels were found to statistically significant. FBS was correlated positively with
be high compared with controls and it is statistically potassium. The P* and r * values were found to be (P*
significant (P<0.05). It was observed that the potassium >0.05 and r * 0.016) and it shows significance. FBS was
and chloride levels were slightly elevated when compared correlated positively with chloride and P* and r* value
with controls. was found to be (P*0.04 and r *0.21) it was also found to
be statistically significant.
Table 2 shows the correlation of FBS with the electrolytes
in which sodium was positively correlated. P* and r *
Table 1: Biochemical Measurements in Type II DM
Parameters Diabetes (50) Controls (50) P * Value
HbA1C (%) 8.8 ± 1.9 4.5 ± 0.4 <0.05
FBS (mg/dl) 186 ± 12 108 ± 13 <0.05
Sodium (meq/l) 162.6 ± 8.5 138 ± 3.3 <0.05
Potassium (meq/l) 5.40 ± 0.65 4.16 ± 0.82 <0.05
Chloride (meq/l) 116 ± 5.5 99.7 ± 0.04 <0.05
P * value < 0.05 then it is considered to be statistically significant

Table 2: Correlation of FBS with the Electrolytes in Type II DM


Electrolytes r * value P * value
+
Sodium(Na ) -0.233 0.017
+
FBS
Potassium (K ) 0.016 >0.05
-
Chloride (Cl ) 0.21 0.04
P* value < 0.05 then it is considered to be statistically significant

DISCUSSION Thus, hypernatremia and hyperosmolarity may be


considered as contributing factors to the occurrence of
The association between blood glucose and serum
DM13.
electrolytes is multi factorial in which it is related to a
number of other factors, which includes age and Present study shows that the DM patients were more
associated conditions. prone to miild hyperkalemia, when compared to the
healthy controls. Some of the studies have shown that
Increased urination leads to loss of electrolytes and water
the exogenous insulin can induce mild hyperkalemia
and results in the imbalance which disturbs sodium and
because it promotes the potassium influx into the skeletal
potassium levels in the body. Studies suggest that
muscles and hepatic cells which increases the activity of
uncontrolled DM can also induce hypovolemic- + +
Na and K ATP ase pump.
hyponatremia due to osmotic diuresis.
Hyperkalemia is also associated with impaired insulin
Furthermore in diabetic ketoacidosis, urinary electrolyte
secretion and decreased peripheral glucose utilization
loss magnify the renal sodium wasting11-12. In the present
which results in carbohydrate intolerance and
study it was found that sodium levels in diabetes patients 14
hyperglycemia .
was found to be high when compared with controls and
sodium was correlated negatively with glucose and it was Elevated serum Cl-levels were found in diabetes patients
found to be statistically significant. and this might be due to diabetic ketoacidosis.
Ketoacidosis cause reduction in blood pH which further
Increased or normal plasma sodium concentrations in the
disturbs acid base balance and leads to the elevation of
presence of hyperglycemia indicate a clinically significant
chloride.
deficit in total body water.
SUMMARY AND CONCLUSION
Poorly controlled DM was implicated in the development
of hypernatremia in few cases. Consequently, in patients To sum up, 50 patients with type II DM and 50 healthy
with uncontrolled DM, serum concentration of [Na+] is controls were screened for electrolyte levels. From the
variable, reflecting the balance between the above studies it was observed that the dysregulation of
hyperglycemia-induced water movement out of the cells glucose homeostasis which may alter due to increase in
that lowers [Na+], and the glucosuria-induced osmotic sodium, potassium and chloride levels. It may be
diuresis, which tends to raise [Na+]. concluded that in type II DM, assessment of electrolytes

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© Copyright protected. Unauthorised republication, reproduction, distribution, dissemination and copying of this document in whole or in part is strictly prohibited.
Int. J. Pharm. Sci. Rev. Res., 40(1), September – October 2016; Article No. 45, Pages: 251-253 ISSN 0976 – 044X

related abnormalities are important to monitor the diabetic nephropathy: a novel predictor of end-stage renal
prognosis of type II DM patients. disease. Diabetes Care. 35, 1591-1597. [PMID: 22498805
DOI: 10.2337/dc12-0226]
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Source of Support: Nil, Conflict of Interest: None.

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